Payer Policy Updates

The Congressional Budget Office said a proposal to add work requirements for Medicaid eligibility would have "a negligible effect on employment status or hours worked by people who would be subject to the work requirements."

CMS proposed two new rules April 27 that would establish national standards of care provided through fee-for-service Medicaid/CHIP and managed care plans, along with a requirement to publicly disclose provider payment rates online. 

The American Medical Association and more than 100 physician and healthcare organizations are asking Cigna to reconsider a policy they say will add administrative costs and burdens and potentially negatively affect patients.  

House Republicans' Medicaid work requirement proposal would result in an estimated 600,000 people losing coverage, the Congressional Budget Office said in an April 25 report.

HHS unveiled its proposed rule that, if finalized, would expand healthcare coverage access to an estimated 129,000 previously uninsured Deferred Action for Childhood Arrivals program recipients.

CMS is upping its proposed number of non-standard ACA plans payers can offer in each region from two to four. 

HHS has removed seven drugs from its initial list of 27 drugs subject to inflation rebates. 

CMS issued a final rule April 5 that, among other things, aims to streamline Medicare Advantage and Part D prior authorizations and clamp down on misleading marketing practices. 

Two Senators are introducing legislation aimed at reducing Medicare Advantage overpayments. 

CMS will move ahead with Medicare Advantage risk adjustment changes payers and some provider groups opposed, but the agency will phase in the model over three years.